HCSA Guide: STPs – What You Need to Know

What Are STPs?

Sustainability and Transformation Plans (STPs), announced in NHS England planning guidance published in December 2015, are five-year plans specifying how local areas will work together to implement the Five Year Forward View and achieve financial stability by 2021.

STPs represent a significant change in the way that the NHS in England will plan and run its services. England has been divided into 44 geographical “footprints" made up of NHS providers, Clinical Commissioning Groups (CCGs), Local Authorities, and other health and care services. These organisations are expected to collaborate to create and deliver “place-based plans” that respond to the challenges in each geographical footprint.

The average population size of a footprint is 1.2 million people, with the smallest covering a population of 300,000, and the largest 2.8 million. The initial deadline for submitting plans to NHS England and other national NHS bodies was the end of June 2016. However, the deadline was extended, with completed plans to be submitted by the end of October 2016. By 16th December 2017 all 44 plans had been made publicly available. More recently STPs have been rebranded “Sustainability and Transformation Partnerships.”

Who are Leading STPs?

A STP lead was appointed for each footprint, with the majority of STP leaders coming from CCGs and NHS Trusts or Foundation Trusts, and a small number coming from local government.

Why Do STPs Matter?

STPs represent a major and wholesale reorganisation of our health and social care services. Therefore, the formation and implementation of STPs is of great significance for the future of the NHS. STPs are based around the principle of collaboration. It is viewed that collaboration is required to improve services, and cooperation is needed to manage resources. This represents a shift away from a focus on competition in previous legislation.

How services are organised can affect what services are available, the quality of the service, patient experience – whether patients get a joint-up holistic service – or whether service if fragmented with breakdown in communication, and the working environment for clinicians.

STPs are perceived as the mechanism to respond to NHS Five Year Forward View, which called for “decisive steps to break down the barriers in how care in provided”. STPs are seen by their architects as the way to bring about much-needed organisational change. They would create systems and structures that provided a more coherent and holistic approach to health and social care in local areas, with decisions taken to reflect the challenges faced by local areas.

What Do STPs Cover?

The plans were required to cover all aspects of NHS spending and achieve financial balance for the NHS. They were expected to set out how the local area will implement national priorities, such as: improving cancer care; introducing seven-day services; improving quality and developing new models of care; improving health and wellbeing; and improving efficiency of services. Each footprint was also tasked with identifying three to five decisions to prioritise.

What is the NHS Five-Year Forward View?

The NHS Five Year Forward View is an NHS England document released in October 2014. It sets out the challenges which face the health and social care system. The three main challenges, or gaps, are highlighted as: closing the health and wellbeing gap; closing the care quality gap; and, closing the funding gap. STPs are viewed as the method to tackle these challenges on a local level.

How Have STPs Been Developed So Far?

The development and introduction of STPs has not been smooth. The intentions behind STPs seem incompatible with the method of delivery. For example, there is a lack of investment for effective transformation, the pace of change has been rushed, there has been insufficient consultation and engagement with hospital doctors, governance and leadership arrangements are unclear, and there has been a lack of transparency and accountability. This has cast a negative shadow over STPs.

What is HCSA’s View on STPs?

While we may see the principle of collaboration as desirable, the current development of STPs has caused great concern. HCSA is not against the principle behind STPs, but is concerned by the process through which STPs are being introduced. STPs present an opportunity to introduce major improvements to quality and effectiveness of NHS services. However, HCSA believes that the current method of development is undermining a sound principle, and eliminating any chance of success.